Local anaesthesia in skin cancer surgery: What the evidence says

Local anaesthetic choice and dosing are such a routine part of skin cancer surgery that it’s easy to fall into habit. But with ongoing supply pressures, evolving research, and the increasing volume of procedures performed in primary care, many GPs are now asking: how low can we safely go with lignocaine concentrations, and does dilution actually work?

In this episode of Life by A Thousand Cuts, A/Prof Tony Dicker breaks down the evidence on lignocaine dosing, including what the newer data tells us about using lower concentrations in day-to-day skin cancer work.

This episode covers:

• Why names like lignocaine, lidocaine, Xylocaine, adrenaline, and epinephrine all trace back to the same core agents.
• How standard concentrations (1% and 2%, with or without adrenaline) compare with the diluted formulations used in dermatologic surgery.
• What the January 2025 Dermatologic Surgery double-blind trial found when comparing 0.25% vs 0.5% lignocaine, and why both were equally effective for pain control, patient satisfaction, and top-ups.
• How these findings relate to tumescent anaesthesia in liposuction, where even more dilute solutions still perform reliably.
• Practical safety limits, including the importance of avoiding unnecessarily large volumes in primary care and maintaining robust processes if your clinic is diluting local anaesthetic.
• Real-world considerations around toxicity, duration of effect, and past adverse events that underline why careful dosing still matters.

If you perform skin cancer procedures in general practice, this is a crisp, evidence-focused update on a tool you use every day, with some simple takeaways you can apply immediately.

Listen to the podcast

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Next steps in your learning journey

🎓  NEW Micro-Course: Introduction to the Dermatoscope
Led by A/Prof Tony Dicker, this short course introduces the dermatoscope as the clinician’s key diagnostic tool for skin examination — a practical foundation for those beginning their journey in skin cancer detection.
✅ Learn how to use the dermatoscope and capture clinical images.
🎖️ 9.5 hours CPD  •  Online  •   $195
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🎓 Micro-Courses in Skin Cancer
Explore short, bite-sized CPD modules in focused topics in skin cancer. Complete in less than 10 hours from only $95.
➡️ Browse Micro-Courses >

🎓 Certificate Courses in Skin Cancer
Explore our university-assured, structured pathway to elevate your knowledge in the diagnosis and treatment of skin cancer.
➡️ Explore full program >

🎓 HealthCert 365 subscription
Prefer flexible learning across many topics? Access 4,000+ CPD hours on-demand with HealthCert 365 — anytime, any topic, one flat annual fee.
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Or explore more educational content in Skin Cancer Surgery.

Life by a Thousand Cuts 

This podcast series is designed to help you enhance your clinical decision-making, procedural skills, and confidence in skin cancer management. Focus on real-world cases, surgical techniques and tips, journal article reviews, diagnostic and management insights, and guest interviews with GPs and specialists.

Listen to the previous episode: When and how to use secondary intention healing under new MBS changes

About A/Prof Tony Dicker

Associate Professor (Skin Cancer) & Course Coordinator MMed (Skin Cancer), The University of Queensland

Tony Dicker has practised full-time Skin Cancer Medicine in Melbourne since 2004, and previously practised in Brisbane. He obtained his PhD from The University of Queensland in molecular biology of skin cancer with Professor Ian Frazer's group at Princess Alexandra Hospital. He then spent three years as a dermatology registrar at the Royal Brisbane and Princess Alexandra Hospitals.

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